Method for predicting prostatic cancer

FIELD: medicine, urology.

SUBSTANCE: the present innovation deals with differential diagnostics of prostatic cancer and other prostatic diseases at the stage of primary inspection. The method includes the detection of PCA and calculation of probability coefficient for prostatic cancer (PCC) by the following formula: where e - the foundation of natural logarithm (e=2.718…), PCA - the level of total blood PCA in ng/ml, V - patient's age in years. At PCC value being above 0.2 one should diagnose prostatic cancer and to establish final diagnosis one should perform polyfocal prostatic biopsy. The method enables to increase accuracy of diagnostics at decreased number of unjustified prostatic biopsies.

EFFECT: higher efficiency of diagnostics.

2 ex

 

The invention relates to medicine, namely, urology, and can be used for differential diagnosis of prostate cancer (PC) and other prostate diseases at primary inspection.

In Russia FPW 5% of all malignant neoplasms in men, occupying the 4th place on morbidity. Mortality from FPW is 3.9% of the total mortality from cancer. In most patients the disease is diagnosed at the stage of clinical manifestations, which often correspond to common forms of FPW. This is especially true in our country, where there is no system of annual screening or preventive examinations of men older than 50 years. Detection of PRV in the early stages gives the possibility of cure of the patient.

The most informative and accessible methods of early detection of PRV are taking a thorough history (including by means of questionnaires IPSS, QoL), digital rectal examination (Dre), transrectal ultrasound (transrectal us). These methods are well studied and successfully applied in screening surveys in many countries, allowing you to diagnose FPW already in the early stages. However, the presence of concomitant diseases of the prostate, such as benign hyperplasia of the present is part of the gland (BPH) and chronic prostatitis (CP), significantly reduce the data characteristics of diagnostic procedures. So, according to different authors, from 2.5% to 12% of patients who were excluded FPW and operated for BPH, morphologically installed FPW.

The closest analogue is the prototype of determining the probability of prostate cancer is the determination of total prostate-specific antigen (PSA) in serum. Matveev BP, Bukharin BV, Matveev V.B. have been prostate Cancer. - M., 1999.- 153 C.

However, the disadvantage of determining the level of PSA remains the fact that the DOG is organospecific, but not cancerspecific marker. This is because the reasons for the increased level of PSA in the serum, in addition to PC, can be an inflammatory process in the prostate, BPH, ischemia or infarction prostate ejaculation prior studies. It is proved that 1 g of the prostate (mud) in BPH secretes of 0.35 ng/ml PSA, while at PC, the average is 3.5 ng/ml In this regard, a small amount of cancerous lesions in the mud rising PSA level may be the same as in BPH large size. Therefore, the problem of early diagnosis of PC in patients with concomitant diseases of the prostate remains relevant.

The objective of the invention is to improve the accuracy of diagnosis of PC and the decline in the number of neopravdanno the x biopsies of the prostate.

This task is achieved by the fact that on the basis of the patient's age and the result of a blood test for levels of total prostate-specific antigen (PSA) blood count criterion of probability of cancer (CWR) and values greater 0,2, diagnose PC with subsequent prostate biopsy, when CWR less than 0.2 FPW is considered to be unlikely.

The method is as follows.

CWR is calculated by the formula

where e is the base of natural logarithm (e=2,718...);

PSA - level of total PSA blood in ng/ml;

V - the patient's age in years.

The value calculated in this way CWR, expressed in dimensionless terms, compared with the number of 0.2. If CWR is less than or equal to 0.2, then prostate cancer in this patient is considered to be unlikely. Otherwise, prostate cancer is considered probable and the patient shows a multifocal spectacle prostate biopsy to install a definitive diagnosis.

The results of examination of patients with symptoms of urinary disturbances showed that the values of the criterion significantly differ in patients with prostate cancer (CWR=0,30±0,009, n=211), and other pathologies of the prostate (CWR=0,24±0,004, n=76).

The effectiveness of this method for the diagnosis of prostate cancer has been tested in Klinicheskaya medicine, far Eastern state medical Institute. Analyzed medical history 287 men aged from 41 to 92 years old, who asked about symptoms of urinary disorder. As a result of running them on the testimony of multifocal spectacle of prostate biopsy with subsequent morphological study of 211-five of them the diagnosis was confirmed prostate cancer. However, the efficiency, specificity, and accuracy of the initial diagnosis, exhibited on the basis of PSA, was 94.7%, 10.4% and 32.8% respectively, while the same parameters for preliminary diagnosis based on the CWR respectively 96,1%, 22.7% and 42.2 per cent.

Example 1. Patient C., 57 years old, complains of lethargy stream when urinating and day pollakiuria. The level of total PSA blood of 8.2 ng/ml, which allows to suspect the presence of PRV in a given patient.

Calculated by the formula

which is less than the proposed threshold value of 0.2, which indicates a low probability of FPW for this patient. The patient was multifocal spectacle biopsy mud. Morphological study did not confirm the existing suspicion on PC.

Example 2. Patient B., 65 years old, complains of difficulty in urination, lethargy jet and night pollakiuria. The level of total PSA blood of 6.1 ng/ml Calculated by the formula

greater than the threshold meant what I 0,2, that indicates a high probability PC for this patient. The patient was multifocal spectacle biopsy mud, exhibited morphological diagnosis FPW II Art.

Thus, the use of the method for the diagnosis of prostate cancer can serve as a reliable test to suspect prostate cancer even when levels of free PSA blood within the "grey zone", i.e. when the PSA level from 4 to 9.9 ng/ml Method is simple to perform, can significantly reduce the number of unwarranted biopsies of the prostate and reduce the cost of performing multi focal biopsy of the prostate with subsequent morphological study of biopsy material.

A method for diagnosing prostate cancer, comprising determining PSA, characterized in that the counting criterion probability of prostate cancer according to the formula:

where e is the base of natural logarithm (e=2,718...);

PSA - level of total PSA blood in ng/ml;

V - the patient's age in years;

and when CWR more than 0,2 patient is prescribed multifocal spectacle biopsy of the prostate.



 

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